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WASH situation underSwachh Bharat MissionReport of an early assessment in 2016

© WaterAid India, 2017Front cover image: WaterAid/ Eliza Powell

WASH situation underSwachh Bharat MissionReport of an early assessment in 2016

Key Highlights

One-third of the surveyed households had access to functional toilet facilities.

33% 72%

72 per cent of the respondents reported washing their hands with soap or ash while 28 per cent washed them only with water.

64 per cent of the households surveyed had at least one member defecating in the open. 14 per cent of households with functional toilets also had at least one member defecating in the open.

64% 20%

20 per cent of households treat water for drinking.

WaterAid WASH situation under Swachh Bharat Mission

44 per cent reported throwing children’s faeces in the garbage, 29 per cent left them in the open, 13 per cent put them in the toilet and 10 per cent, into a drain or ditch.

36% 44%

Around 36 per cent of the respondents with functional toilets stated that they have constructed them after the launch of the Swachh Bharat Mission (SBM).

6%

6 per cent of respondents reported that in the last one year they had heard of harassment and sexual violence against women stepping out to defecate in the open.


Objectives of the study:

1. To conduct a process and effectiveness

assessment of the SBM (Gramin) in select

states and districts where WAI and UNICEF

have their interventions.

2. Situational assessment of behaviour

change, assistance received and capacity

building.

3. Effectiveness evaluation (short-term

and intermediate), involving assessment of

the extent to which objectives of the SBM

are being achieved in terms of planning,

implementation, institutional

arrangements and sustainability.

4. Provide concrete recommendations for

the SBM.

Methodology:

The study was conducted in nine states and

34 districts of India (see Table 1). The states

were Andhra Pradesh, Bihar, Chhattisgarh,

Jharkhand, Karnataka, Madhya Pradesh,

Odisha, Telangana, and Uttar Pradesh. 18 gram

panchayats (GP) per state were selected

randomly from within the WAI and UNICEF

intervention districts. From each GP, 24

households were randomly surveyed. In all, 162

GPs and 3,904 households were interviewed.

Primary data collection through the survey was

complemented with secondary data analysis

using the Ministry of Drinking Water and

Sanitation’s (MDWS) Management Information

System (MIS) and primary information collected

from the development partners.

The study used representative sampling

methods at the GP and household level,

catering to the aim of providing useful insights

about the districts in which WAI and UNICEF are

intervening. This affects any state level

aggregated figures, as there is a bias related to

the fact that these intervention areas are

comparatively less developed than the average.

This is illustrated by the resulting composition

of the sample, covered around one-third of the

households from remote and difficult-to-access

villages, and near to a quarter from interior but

accessible villages. 86 per cent of the surveyed

households belonged to either scheduled tribes

(17 per cent), scheduled castes (28 per cent) or

other backward castes (41 per cent). In 44 per

cent of the households, no family member had

pursued their studies beyond the Ninth

standard. 83 per cent resided in mud or

semi-pucca houses, and around 68 per cent of

the respondents were female.

On 2 October 2014, marking the 150th birth anniversary of Mahatma Gandhi, the Prime Minister of India launched the Swachh Bharat Mission (SBM) with the aim of accelerating efforts towards achieving a Swachh Bharat (Clean India) in rural and urban India by 2019.

With support from the Centre for Operations Research and Training (CORT) in Vadodara, WaterAid India (WAI) undertook a concurrent assessment of rural SBM implementation across nine states in January to April 2016, to assess the status of WASH, and propose necessary policy implementation changes.

6


TABLE 1:

Details of districts and households included in the assessment

States

Andhra Pradesh Chittoor, Nellore 18 430

Districts covered Number ofgram panchayats(GP) covered

Number ofhouseholdssurveyed

Total 34 162 3904

Bihar Madhubani, Muzaffarpur, Aurangabad,

Khagaria, Bhagalpur

18 432

Chhattisgarh Kanker, Rajnandgaon, Korba, Raigarh,

Dantewada

18 435

Jharkhand Sahibganj, Pakur, Ramgarh 18 433

Karnataka Raichur, Yadgir 18 434

Madhya Pradesh Chhatarpur, Datia, Panna, Sehore,

Chhindwara, Harda, Indore,

Narsinghpur

18 432

Odisha Debagarh, Bhadrak 18 432

Telangana Medak, Warangal 18 432

Uttar Pradesh Chitrakoot, Fatehpur, Mahoba,

Balrampur, Mirzapur

18 442

7


Drinking water facilities and their management:

Overall, 92 per cent households surveyed

had an improved drinking water source.

Through the study, it was found that the main

sources of water for 27 per cent households

were public taps or standpipes, 26 per cent

used hand pumps and 15 per cent homes had

access to tube wells or borewells and piped

water within their premises or plots. Around 72

per cent respondents mentioned that water was

supplied everyday throughout the year,

including in the summer.

Across all states, it was largely the women

(94 per cent) who fetched water for their

households.

1 Note: Open defecation behavior (64 per cent )reported above is lower than the proportion of households without functional toilets (66 per cent). This can be attributed to the usage of shared or community toilets and being based upon the perception of the respondent about the defecating behavior of other family members, which may not be absolutely accurate.

Toilet facilities and utilisation:

Toilet usage is a continued concern in the

SBM (G) programme. In all, one-third (33 per

cent) of surveyed households had access to

functional toilets within the household, the

least being in the states of Jharkhand, Odisha,

and Karnataka (Figure 1). Among those who

have functional toilets, 36 per cent are stated

to have constructed toilets after the launch of

SBM (Figure 2). This shows an accelerated

movement towards sanitation under the SBM.

Poverty emerged as the major reason for not

having a toilet (Figure 6). Open defecation was

still found to be a big problem. Overall, 64 per

cent1 of the respondents reported that at least

one member of their family defecates in the

open (Figure 3). 14 per cent of households

Key Findings

FIGURE 1:

Availability of functional toilets across nine states

0

20

Telangana

n=3904figures in percentages

MadhyaPradesh

Chhattisgarh AndhraPradesh

Bihar All UttarPradesh

Karnataka Odisha Jharkhand

51 4842

35 35 3326 22 21

15

40

60

80

100

having functional toilets also have at least one

member defecating in the open (Figure 4).This

figure, likely to be much higher in reality as

households typically underreport open

defecation, highlights the need to promote

behaviour change and create ownership among

people towards safe sanitation practices.

8


Drinking water facilities and their management:

Overall, 92 per cent households surveyed

had an improved drinking water source.

Through the study, it was found that the main

sources of water for 27 per cent households

were public taps or standpipes, 26 per cent

used hand pumps and 15 per cent homes had

access to tube wells or borewells and piped

water within their premises or plots. Around 72

per cent respondents mentioned that water was

supplied everyday throughout the year,

including in the summer.

Across all states, it was largely the women

(94 per cent) who fetched water for their

households.

Toilet facilities and utilisation:

Toilet usage is a continued concern in the

SBM (G) programme. In all, one-third (33 per

cent) of surveyed households had access to

functional toilets within the household, the

least being in the states of Jharkhand, Odisha,

and Karnataka (Figure 1). Among those who

have functional toilets, 36 per cent are stated

to have constructed toilets after the launch of

SBM (Figure 2). This shows an accelerated

movement towards sanitation under the SBM.

Poverty emerged as the major reason for not

having a toilet (Figure 6). Open defecation was

still found to be a big problem. Overall, 64 per

cent1 of the respondents reported that at least

one member of their family defecates in the

open (Figure 3). 14 per cent of households

having functional toilets also have at least one

member defecating in the open (Figure 4).This

figure, likely to be much higher in reality as

households typically underreport open

defecation, highlights the need to promote

behaviour change and create ownership among

people towards safe sanitation practices.

FIGURE 3:

Proportion of Households with at least one member defecating in the open

0

20

Jharkhand Karnataka Odisha UttarPradesh

All Bihar Chhattisgarh MadhyaPradesh

Telangana AndhraPradesh

83 82 82

7064 61 59 59

41 3940

60

80

100


FIGURE 2:

Proportion of households with toilets constructed in the past one year

0

20

Odisha Karnataka AndhraPradesh

Jharkhand Bihar All MadhyaPradesh

Chhattisgarh Telangana UttarPradesh

6560

4439 39 36

31 3125

19

40

60

80

100


9


FIGURE 4:

Proportion of households with members defecating in the open despite having functional toilets

FIGURE 5:

Proportion of respondents who reported having heard of incidents of sexual assault or violence on women venturing out for open defecation in the past year.

0

20

UttarPradesh

Karnataka All Bihar MadhyaPradesh

Chhattisgarh Telangana Jharkhand AndhraPradesh

Odisha

2414

6 5 5 2 2 2 1 1

40


0

20

Karnataka Chhattisgarh Jharkhand MadhyaPradesh

Odisha UttarPradesh

All Telangana Bihar AndhraPradesh

23 19 18 17 15 14 14 11 10 8

40


FIGURE 6:

Reasons for having no toilet built in household till date

0

20

Cannotafford

to buildtoilet/

poverty

Will buildwhen funds

areavailable

It is forgovernment

to buildthe toilet

No spaceto builda toilet

in house

Do notknow

processof getting

help

Do notknowabouthow to

build toilet

Others No needof toilet

Do notknow

59

2924

13 115 3 2 2

40

60

80

100

figures in percentages

10


FIGURE 7:

Sources of assistance received for toilet construction

Government92%

CSR1%

Others4%

NGO3%

Hygiene practices:

Most respondents mentioned that they

usually wash their hands before eating (84 per

cent), after defecation (84 per cent), after eating

(67 per cent), and if they are dirty (55 per cent).

72 per cent of the respondents shared that they

wash their hands with soap or ash, while 28

per cent wash their hands only with water

(Figure 12). This represents a considerable

proportion of people following unsafe hygiene

practices. Around 63 per cent of respondents

reported havingre ceived messages on

handwashing, mainly from television (45 per

cent), anganwadi workers, newspapers, school

teachers, radio, accredited social health

activists (ASHA) and panchayat members

(Figure 14). This shows the importance of media

in the dissemination of messages. 20 per cent

of the households reported that they treat their

water before drinking (Figure 8). Regarding

cleanliness of toilets, again only 20 per cent

households reported cleaning them on a daily

basis (Figure 9). These findings show that there

is a case for greater emphasis on hygiene

awareness and education.

FIGURE 8:

Proportion of households treating water

0

20

Karnataka Telangana Jharkhand MadhyaPradesh

All Chhattisgarh AndhraPradesh

Bihar UttarPradesh

Odisha

47

25 25 22 20 18 18 148 8

40

60

80

100


11


n=1286

n=1286

FIGURE 9:

Frequency at which the toilet is cleaned in the household

Everyday20%

Twice a week37%

Weekly34%

Less frequent3%Fortnightly 6%

FIGURE 10:

Material used to clean toilets

Others10%Soap, disinfectants

31%

Phenyl34%

Acid36%

Only water19%

Washing powder

27%

FIGURE 11:

Instances when soap/cleaning agent is used to wash hands

Always22%

Others1%Beforepreparingfood

2%

Beforeeating

27%Afterdefecation

49%

FIGURE 12:

Ways in which respondents wash their hands

With water only28%

With soap/ash72%

n=3904 n=3904

12


FIGURE 13:

Types of hygiene advice received

0

20

None Wash handswith soap

Drink safewater

Wash hands Alwaysuse atoilet

Store watersafely

Good foodhygiene

Wastewater/stagnant

watermanagement

Others(safe

disposalof babiesfaeces)

35 33 31 3025

20 19

4 3

40


FIGURE 14:

Sources of hygiene advice

0

20

TV

Do

not k

now

AWW

New

spap

er

Scho

ol te

ache

r

Radi

o

ASH

A

ANM

Post

ers/

pict

ures

Nei

ghbo

ur/

rela

tives

Mag

azin

es

NG

O/C

BO

wor

kers

Oth

ers

Pam

phle

ts/

leafl

ets

Mem

ber o

f vill

age

heal

thsa

nita

tion

com

mitt

ee

Panc

haya

t mem

ber/

com

mun

ity m

eetin

g

4536

14 13 10 8 8 6 6 5 4 3 3 3 1 1

40

60

80

100


When asked how they dispose of their

children’s faeces, 44 per cent reported that they

throw it with the garbage, 29 per cent disposed

of faeces in the open, 13 per cent in toilets and

10 per cent in drains or ditches (Figure 15). 85

per cent reported they always cleaned their

hands after handling children’s faeces. After

disposal of the faeces, 75 per cent washed their

hands with soap or ash, while 15 per cent

washed only with water. These findings

emphasise a need for better hygiene education

on disposal of children’s faeces.

Respondents were also asked what they do

to prevent children from getting diarrhoea. Key

responses were (1) boiling of drinking water (31

per cent), (2) eating well cooked food (15 per

cent), and (3) washing of hands and vegetables

with clean water before cooking (17 per cent).

It was also found that mostly women (94

per cent) fetched water, and 87 per cent were

satisfied with water quality in terms of

freshness, safety, taste, etc., but had

reservations about its appearance and odour.

Solid and Liquid Waste Management:

Most households reported that they

discarded their garbage by throwing it in

farmland (51 per cent), while others reported

throwing it on the road, burying or burning it.

Only 12 per cent of the households surveyed

were found to throw it in garbage bins, while the

garbage of 16 per cent was collected by

sweepers or used for biogas and animals

(Figure 16). Liquid waste was reported to be

mostly flowing into open drains (47 per cent)

while 35 per cent reported disposing it in open

grounds. (Figure 17). This implies that Solid

and Liquid Waste Management is another area

which needs adequate attention from the

government.

13

































FIGURE 15:

Disposal methods of children's faeces

0

20

Left in open Thrown in garbage Put into toilet Put into drain/ditch Other, buried Children using open fieldor toilet

29

44

13 105 3

40

60

80

100

figures in percentages

FIGURE 16:

Solid waste disposal in households

0

20

Disposed onfarmland

Burn it Buried inthe soil

Thrown onto streets

Given toanimals

Thrown in towastebins

Others;collected bysweepers,

used for biogas

51

2111

23

916

12

40

60

80

100









government.

14








































government.

FIGURE 17:

Liquid waste disposal in households

0

20

Open drain Thrown onopen ground

Thrown in ponds Discarded in farms Discarded inkitchen garden

Others

47

35

7 7 2 1

40

60

80

100


15


Conclusion

1. Increasing boots on the ground –

Interpersonal communication is critical for

changing behaviour and making open

defecation unacceptable. Lack of human

resources and capacity to work on this

‘soft’ side of the campaign is still a

bottleneck for progress. Mechanisms to

find, train and (temporarily) engage

committed individuals to motivate

communities is critical. With adequate

incentives based on outcome, coordination

and support, they have already proven that

they are able to drive change at a dramatic

speed. Resources from the Information,

Education and Communication budget can

be made available for this, but clear

guidance and political drive are necessary

to overcome practical and bureaucratic

obstacles. These people should be geared

and trained to address not just defecation

behaviour, but also other hygienic

practices including hand washing, handling

of children’s faeces and solid and liquid

waste management. While focusing on

behaviour change communication, it

should also ensure that the measures and

tools used for change should not be

coercive and punitive, as being observed in

several cases. This is more important for

including the marginalised sections.

Cross-sectoral effort – Sanitation

needs to be an integral element of all

environmental health programmes,

especially in child health and nutrition. If

the National and State Governments get

The study shows that open defecation is still a prevalent practice in many districts of the country. This is related to both; a lack of behaviour change and poor access to functional facilities. The study also confirms a large gap in terms of hygiene awareness and education. We are far behind the universal standards of hygiene in terms of hand washing with soap. Even in solid and liquid waste management and proper disposal of children’s faeces, we are trailing behind acceptable levels.

Although the Swachh Bharat Mission addresses most of these aspects to varying degrees, the evidence emerging from the research suggests that its ambitious vision requires further measures in order to be successful. A new social norm needs to be created, in which open defecation becomes an unacceptable practice, and environmental cleanliness becomes as important as cleanliness inside the house. According to the research and WAI’S experience, this will only be possible when the following four areas are strengthened:

their own houses in order as a matter of

priority, by ensuring that health centres,

schools and anganwadis have adequate

water, sanitation and hygiene facilities that

are properly maintained, it could lead to

transformative change. It would not just

demonstrate the government’s leadership

in practice, but also inculcate healthy

habits in future generations. However, this

will require high levels of cross-ministerial/

department convergence and collaboration,

that unfortunately, do not yet exist.

2. Monitoring usage through independent

verification – What gets measured gets

done, so having the right verification

systems can have a big impact. In addition

to being independent, a verification system

would have to first, measure toilet use and

open defecation-free communities reliably,

without simply using the presence of toilets

as a proxy indicator. This would discourage

construction-driven implementation of

SBM. It would also need to be

disaggregated by districts, or at least

divisions, to act as an incentive for districts

to deliver, by creating inter-district

competition.

3. Adaptive learning – Timely feedback on

what works and what does not at the

implementation level is critical to learn and

adapt the direction of the mission.

Although there have been improvements

through informal mechanisms, more

institutionalised efforts are important, such

as the Rapid Action Learning Units or

similar mechanisms that could be set up at

state and national levels, to contribute to

the review of progress and course

correction. These efforts will be critical as

SBM starts to focus more intensively on

hygiene behaviour and solid and liquid

waste management.

16


1. Increasing boots on the ground –

Interpersonal communication is critical for

changing behaviour and making open

defecation unacceptable. Lack of human

resources and capacity to work on this

‘soft’ side of the campaign is still a

bottleneck for progress. Mechanisms to

find, train and (temporarily) engage

committed individuals to motivate

communities is critical. With adequate

incentives based on outcome, coordination

and support, they have already proven that

they are able to drive change at a dramatic

speed. Resources from the Information,

Education and Communication budget can

be made available for this, but clear

guidance and political drive are necessary

to overcome practical and bureaucratic

obstacles. These people should be geared

and trained to address not just defecation

behaviour, but also other hygienic

practices including hand washing, handling

of children’s faeces and solid and liquid

waste management. While focusing on

behaviour change communication, it

should also ensure that the measures and

tools used for change should not be

coercive and punitive, as being observed in

several cases. This is more important for

including the marginalised sections.

Cross-sectoral effort – Sanitation

needs to be an integral element of all

environmental health programmes,

especially in child health and nutrition. If

the National and State Governments get

their own houses in order as a matter of

priority, by ensuring that health centres,

schools and anganwadis have adequate

water, sanitation and hygiene facilities that

are properly maintained, it could lead to

transformative change. It would not just

demonstrate the government’s leadership

in practice, but also inculcate healthy

habits in future generations. However, this

will require high levels of cross-ministerial/

department convergence and collaboration,

that unfortunately, do not yet exist.

2. Monitoring usage through independent

verification – What gets measured gets

done, so having the right verification

systems can have a big impact. In addition

to being independent, a verification system

would have to first, measure toilet use and

open defecation-free communities reliably,

without simply using the presence of toilets

as a proxy indicator. This would discourage

construction-driven implementation of

SBM. It would also need to be

disaggregated by districts, or at least

divisions, to act as an incentive for districts

to deliver, by creating inter-district

competition.

3. Adaptive learning – Timely feedback on

what works and what does not at the

implementation level is critical to learn and

adapt the direction of the mission.

Although there have been improvements

through informal mechanisms, more

institutionalised efforts are important, such

as the Rapid Action Learning Units or

similar mechanisms that could be set up at

state and national levels, to contribute to

the review of progress and course

correction. These efforts will be critical as

SBM starts to focus more intensively on

hygiene behaviour and solid and liquid

waste management.

17


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